Association Between Pre-hypertension and Cardiovascular Outcomes: A Systematic Review and Meta-analysis of Prospective Studies
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The quantitative associations between prehypertension or its separate blood pressure (BP) ranges and the risk of main cardiovascular diseases (CVDs) have not been reliably documented.
We performed a comprehensive search of PubMed (1966 to June 2012) and the Cochrane Library (1988 to June 2012) without language restrictions. Prospective studies were included if they reported multivariate-adjusted risk ratios (RRs) and corresponding 95 % confidence intervals (CIs) of desirable outcomes, including fatal or non-fatal incident stroke, coronary heart disease, myocardial infarction (MI) or total CVD events, with respect to prehypertension or its separate BP ranges (low range: 120–129/80–84 mmHg; high range: 130–139/85–89 mmHg) at baseline with normal BP (<120/80 mmHg) as reference. Pooled RRs were estimated using a random-effects model or a fixed-effects model.
Twenty-nine articles met our inclusion criteria, with 1,010,858 participants. Both low-range and high-range prehypertension were associated with a greater risk of developing or dying of total CVD (low-range: RR: 1.24; 95 % CI: 1.10 to 1.39; high range: RR: 1.56; 95 % CI: 1.36 to 1.78), stroke (low-range: RR: 1.35; 95 % CI: 1.10 to 1.66; high-range: RR: 1.95; 95 % CI: 1.69 to 2.24) and myocardial infarction (MI) (low range: RR: 1.43; 95 % CI: 1.10 to 1.86; high range: RR: 1.99; 95 % CI: 1.59 to 2.50). The whole range prehypertension had a 1.44-fold (95 % CI: 1.35 to 1.53), 1.73-fold (95 % CI: 1.61 to 1.85), and 1.79-fold (95 % CI: 1.45 to 2.22) risk of total CVD, stroke, and MI, respectively. There was no evidence of publication bias.
Prehypertensive patients have a greater risk of incident stroke, MI and total CVD events. The impact was markedly different between the low and high prehypertension ranges.
KeywordsPrehypertension Cardiovascular diseases Meta-analysis
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Conflict of Interest
Xiaofan Guo, Xiaoyu Zhang, Liang Guo, Zhao Li, Liqiang Zheng, Shasha Yu, Hongmei Yang, Xinghu Zhou, Xingang Zhang, Zhaoqing Sun, Jue Li, and Yingxian Sun declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
- 1.World Health Organisation. The global burden of disease: 2004 update. Geneva: World Health Organisation; 2008.Google Scholar
- 17.Guo X, Zhang X, Zheng L, Guo L, Li Z, Yu S, et al. Prehypertension is not associated with all-cause mortality: a systematic review and meta-analysis of prospective studies. PLoS One. 2013;8(4):e61796.Google Scholar
- 21.Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Cochrane Collaboration, 2008.Google Scholar
- 45.Hadaegh F, Mohebi R, Khalili D, Hasheminia M, Sheikholeslami F, Azizi F. High normal blood pressure is an independent risk factor for cardiovascular disease among middle-aged but not in elderly populations: 9-year results of a population-based study. J Hum Hypertens. 2013;27(1):18–23.PubMedCrossRefGoogle Scholar
- 57.The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1997; 157:2413–46.Google Scholar
- 58.1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension, Guidelines Subcommittee. J Hypertens. 1999; 17:151–83.Google Scholar
- 59.Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105–87.PubMedCrossRefGoogle Scholar